异氟烷静吸复合麻醉与小剂量氯胺酮全静脉麻醉在小型猪瓣膜修复术中的应用  

Isoflurance-based Intravenous and Inhalation Combined Anesthesia Versus Low-dose-ketamine-based Total Intravenous Anesthesia for Valvuloplasty in Minipigs

作　　者：宋兵[1] 邢旺[1] 柳德斌[1,2] 任旭东[1] 张巧燕[1] 庄著伦[1] 

机构地区：[1]兰州大学第一医院胸心外科,兰州730000 [2]清华大学第一附属医院心脏中心,北京100016

出　　处：《四川大学学报（医学版）》2010年第5期858-861,共4页Journal of Sichuan University(Medical Sciences)

基　　金：兰州大学中央高校基本科研业务费专项资金(zujbky-2009-102)资助

摘　　要：目的比较异氟烷静吸复合麻醉与小剂量氯胺酮全静脉麻醉在小型猪瓣膜修复手术中的麻醉效果。方法小型猪24只。麻醉诱导:氯胺酮3~5 mg/kg肌注,戊巴比妥钠15~20 mg/kg静注;麻醉维持:随机分为异氟烷组(I组)和氯胺酮组(K组),每组12只。I组异氟烷1.0~1.5最低肺泡气有效浓度(MAC)吸入,芬太尼20~25μg/(kg.h)、咪唑安定0.10~0.20 mg/(kg.h)和维库溴铵0.10~0.15 mg/(kg.h)静注;K组氯胺酮5 mg/(kg.h)、戊巴比妥钠8~10 mg/(kg.h)和维库溴铵0.10~0.20 mg/(kg.h)静注。记录手术各期的一般情况,血流动力学、动脉血气及麻醉并发症等。结果死亡2只,均非麻醉因素。I组和K组呼吸机辅助时间分别为(281.3±34.7)min和(330.4±27.0)min,术后苏醒时间分别为(21.6±4.1)min和(67.8±8.5)min,差异有统计学意义(P<0.05);体外循环(CPB)期间I组平均动脉压(MAP)低于K组,但差异无统计学意义;CPB停机即刻I组乳酸值小于K组(P<0.05);K组1只小型猪拔管后呼吸抑制,行二次插管。结论对于小型猪瓣膜修复术,异氟烷静吸复合麻醉效果稳定、术后苏醒快、并发症少,应为首选;但在资源紧缺情况下,小剂量氯胺酮全静脉麻醉方案也可选择。Objective To compare the effectiveness of anesthesia between Isoflurane-based intravenous and inhalant combined approach and low-dose-ketamine-based total intravenous approach for valvuloplasty in minipigs.Methods Twenty four minipigs were given 3-5 mg/kg ketamine intramuscularly and 15-20 mg/kg pentobarbital intravenously for anesthetic induction and intubation.They were then randomly divided into two groups,each with 12 minipigs.In group I(isoflurane),the minipigs received isoflurane 1.0-2.0 minimum alveolar concentration(MAC),fentanyl 20-25 μg/(kg·h),midazolam 0.1-0.2 mg/(kg·h) and pipecuronium 0.10-0.15 mg/(kg·h) for maintenance.In group K(ketamine),the minipigs were given ketamine 3-5 mg/(kg·h),pentobarbital 8-10 mg/(kg·h) and pipecuronium 0.10-0.15 mg/(kg·h) intravenously.The general peri-operation characteristics were recorded.Hemodynamics,blood gas and respirations were monitored.Anesthetic complications were observed.Results Two minipigs died from causes other than anesthesia.The minipigs in group I had lower mean aortic pressure(MAP) than those in group K during cardiopulmonary bypass(CPB),but without a statistical significance.The minipigs in group I had significantly lower levels of lactic acid than those in group K after CPB cessation(P<0.05).The times on analepsia were(21.6±4.1) min and(67.8±8.5) min for group I and group K,respectively.The times on ventilator were(281.3±34.7) min and(330.4±27.0) min for group I and group K,respectively.The differences were significant(P<0.05).One minipig in group K was intubated for espiratory depression after surgery.Conclusion The isoflurane-based intravenous and inhalant combined anesthesia was preferable for valvular reparation in minipigs.However,low-dose-ketamine-based total intravenous anesthesia is also a good choice in the circumstance of limited resources.

关 键 词：异氟烷 氯胺酮 瓣膜修复 小型猪 体外循环 

分 类 号：R614[医药卫生—麻醉学]